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Surgery > Basic GI SX Part 2 > Flashcards

Basic GI SX Part 2 Flashcards

1
Q

How far on either side of a FB in the intestines do I want to milk fecal matter away from the FB before applying the doyen forceps?

A

10 cm

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2
Q

where is the longitudinal incision made for an enterotomy?

A

the antimesenteric border in the health intestine immediately distal to the FB

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3
Q

What suture type is used for an enterotomy?

A

All suturing is done with 3-0 to 4-0 polyglactin 910 (Vicryl), polyglycolic acid (Dexon), polydiazoxinone (PDS) or polyglactone (Maxon) on a taper cut needle.

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4
Q

What layers does the gambee pattern include in an enterotomy closure?

A

serosa, muscularis, and submucosa (not mucosa- helps to decrease eversion of the mucosa)

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5
Q

If the animal has hypoproteinemia or cachexic, what suture pattern should be used?

A

a simple continuous or inverting Cushing, Connell or Lembert pattern is performed

provides watertight seal and god serosa-serosa apposition

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6
Q

Why is surgical gut suture not good to use in either the stomach or colon?

A

stomach: acid breaks suture down too fast
colon: collagenases speed up tensile strength loss

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7
Q

How can a linear FB be removed with a single enterotomy incision vs. multiple?

A

use a red rubber catheter to detach the FB from the wall of the intestine and push it aborally toward the stomach

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8
Q

Ideal suture choice for closing an enterotomy?

A

4-0 PDS

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9
Q

What is the concern with using a Cushing pattern for an enterotomy closure?

A

eversion causes narrowing of intestinal lumen

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10
Q

What is a key thing to address before you start making enterotomy incisions to remove a linear FB?

A

relieve the anchor point (under tongue or at pylorus)

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11
Q

What are the Ad/DisAd to performing anastomoses?

A
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12
Q

How do you want to cut the aborad side the intestine for an anastomosis?

A

60 degree angle to match the dilated orad side

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13
Q

How many mL water do you use for the leak test?

A

10 mL

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14
Q

If a dog has an omental resection and peritonitis, how does this affect mortality?

A

>90%

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15
Q

How much vital tissue should be removed with the devitalized tissue with an intestinal resection?

A

1.5 cm

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16
Q

How much SI can be removed?

A

80%

Resections greater than 75-80% may result in weight loss, cachexia, macrocytic anemia, hypoproteinemia and chronic diarrhea.

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17
Q

Why are approximating patterns preferred over inverting/everting for intestinal R/A?

What are of the intestine would an inverting suture possibly be better?

A

1) create an increased lumen diameter when comparing to everting or inverting patterns
2) give rapid and precise primary intestinal healing
3) minimize the potential for postoperative adhesion formation.

Inverting w/ colon d/t watertight seal to prevent leakages of bacteria and life-threatening peritonitis

18
Q

What suture pattern is preferred for an R/A?

What tissue layer is critical to include in the incision?

A

simple interrupted approximate or crushing

submucosa (layer of greatest strength)

19
Q

Which border do you start when suturing an anastomosis?

A

mesenteric (location of most fat and hardest to suture)

20
Q

After the anastomosis, what is performed?

A

simple continuous on the mesentery and an omental wrap

21
Q

Two common causes of intussusception? Common associated age?

A

endoparasites- young animals

neoplasia- older animals

22
Q

Where is the common location for an intussusception to occur?

A

ileocecal colic jxn

23
Q

What is the sign on U/S for an intussusception?

A

bullseye sign

24
Q

What will an intussusception feel like on palpation?

What radiographic signs are typically observed?

A

sausage

gas distention upper GI, Ba enema

25
Q

What can be performed to prevent reoccurrence of an intussusception?

Which procedure has more associated complications?

A

enteropexy and enteroplication

enteropexy

26
Q

What do we call the different parts of the invaginating bowel in an intussusception?

Which usually has to be resected?

A

a proximal bowel segment invaginates (intussusceptum) into a distal section of bowel (intussuscipiens)

intussusceptum often has to be resected

27
Q

What are some conditions that predispose to intussusception?

A
28
Q

What is the difference in the presentation of a dog with ileocecocolic vs. a more proximal intussusception?

A

Patients with high intussusceptions usually undergo profuse vomiting, rapid dehydration and early death. Ileocolic intussusceptions often present with a history of sporadic vomiting, inappetence, or bloody stools.

29
Q

When is reduction not possible and an R/A needs to be performed on an intussusception?

A

When mature adhesions have formed between the invaginated and ensheathing layers, reduction is usually not possible, and resection and anastomosis are performed.

30
Q

Where is intestinal volvulus most likely to occur (rotation along mesenteric axis)? Why?

A

jejunum and proximal ileum

free mesentery

31
Q

Which breed is predisposed to intestinal volvulus? Cause?

Most common C.S.?

A

GSH (large dogs, males 4:1)

many causes: tumor, EPI, recent laparotomy

hematochezia (vomiting not common unlike w/ GDV)

32
Q

What is the concern with reducing the volvulus to assess intestinal viability

A

the release of endotoxins

if intestine already necrotic, should perform R/A w/o reduction of the volvulus to prevent the release of endotoxins

33
Q

Signs of megacolon

A
34
Q

Age of cats with megacolon?

A

range 1-15yrs

average 5 years (aka middle-aged cats)

35
Q

Why are fleet enemas avoided in cats?

A

Hypertonic sodium phosphate (Fleet) enemas should be avoided in cats because they may cause dehydration, hypernatremia, hyperphosphatemia, and tetany due to hypocalcemia.

36
Q

Medical Tx for megacolon in casts?

A

cisapride (motility-causing the release of acetylcholine from the enteric nervous system which stimulates colonic smooth muscle to contract. )

lactulose (stool softener)

37
Q

For a subtotal coletomy procedure, what is resected and what is anastamosed? Suture pattern and type?

What should be administered during sx?

A

The proposed resection sites are at the ileocecal junction and in 1-2 cm cranial to the brim of the pubis.

The ileum is anastomosed to the colon in end-to-end (or end to side) fashion using a simple interrupted pattern of 4-0 prolene.

Abx- Cefoxitin

38
Q

What is the main complaint from owners post subtotal coletomy for megacolon in cats?

A

The major complaint by some owners is chronic perineal soiling caused by the loose feces. (cats will have soft cow-pie feces for remainder of life)

39
Q

What are some considerations for colonic sx?

A
40
Q
A

Surgery (8 decks)

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